tesa lg Conserve ECYCLE WATER ania City of Santa Fe Utility Billing Department Release of Liability and Application for Service Please Print Service Address aa Name of Property Owner _ Owner's Mailing Address Owner's Phone Number —__ Tenant's Information ‘Tenant's Name (Social Security, pe eee uesetseeie Spouse/Partner Name _ Social Security # _ ‘Tenant's Mailing Address aa — Home Ph Cell Ph Alternate Ph, Driver’s License No, State, Previous Address Lagree to comply with the rules and regulations as established by the City of Santa Fe as a condition of service including the terms as stated on the reverse of this application. I swear or affirm wnder penalties provided by law that the information on this application is true and correct. Legal Property Owner's Signature Date Tenant's Signature Date “Recount Nomber ae Sar Water Deposit] Refuse Deposit Residential Commercial Water Storm Water Refuse Sewer Tecount Set Up By Gwners ABS | Owners Ack? —] Owners NameCity of Santa Fe Utility Billing Information Rates and other information: The ordiiances and rates ofthe Santa Fe Utility Billing, Waste Water, Solid Waste and Water Divisions are on file and available for public inspection at our offices located at 801 W San Mateo Rd, at City Hall, 200 Lincoln Ave and on our website at wwrw.santafenm,gov Service Fees: Meter Connection $25.00 Meter Reread $25.00 ‘Meter Test/Replacement $125.00 Reconnection for Non-Payment During Working Hours $25.00 After Working Hours $100.00 Lien Filing (per Utility) $30.00 ‘Theft of Service/Tampering $200.00 Returned Check Fee $15.00 Additional charges may also apply to the services listed above, including Gross Receipts Tax. Past Due Charges and Fees: Past due accounts will be assessed a Finance Charge of. 115% per month, Additional Information Deposits are required for all tenants. Interest is not paid on deposits. Refunds will not be made until the ‘Termination of Service: Please contact, Customer Service at least five (5) business days in advanee of your move in order to discontinue service. Ifyou fal to notify us, serviee will continue to be billed under your name and you will be held responsible as the customer of record. Right of Access: The City of Santa Feis authorized to enter on private premises for the purposes of inspecting, maintaining, testing, reading, changing, installing, oF removing its meters (City Code 25-1.6B). City Programs: Ifyou feel the following programs may apply to you, please contact, Customer Service for information on our Low Income, Vacancy Credit and Water Conservation programs, Contact Information Customer Service (505) 955-4333 Solid Waste (505) 955-2200 Waste Water (505) 955-4650 Water Conservation (505) 955-4225, Water Violations (505) 955-4222 To report water emergencies only After Hours, holidays and weekends (505) 985-4300 ‘To report sewer emergencies only After Hours, holidays and weekends (505) 955-4666 account is closed. It is agreed that if the tenant has an outstanding balance for any utility service at a previous address, u been made. ty service may not be initiated until that balance is paid in full or other arrangements for payment have Billing Disputes: If you are disputing your utility bill, payment arrangement or discontinuance of service, you must submit this dispute, in writing, to Customer Service within 30 days of the occurrence. The Utility Billing Division will respond to your dispute. Ifyou are not satisfied with the response, you may submit a written appeal to the Utility Billing Division Director and provide a Non Refundable Hearing Fee of $50.00, In order to have same day service after 2:30 P.M., customers may be charged a $100.00 After Working Hour Fee. Otherwise, requests after 2:30 P.M. will be processed the following business day. Itis the customer's responsibility to ensure clear access to the water meter. Meter cans must be clear of obstructions such as vegetation, vehicles, dirt, large objects and trash, Obstructed meters may be charged a Meter Roread charge. Only Authorized City of Santa Fe Personnel are permitted to open meter can, Any unauthorized entry of the meter can, will be assessed a §200.00 Tampering Fee